PUNE EYECON-2019

Early Bird Registration Form

Name *

Address *

City *

State*

Pin *

Tel. Clinic

Res

Mobile No. *

Email *

MMC Regd No. *



Category Early Bird Till 31st Dec 2018 1st Jan 2019 - 28th Feb 2019 1st March 2019 - 31st March 2019
Consultant Rs. 1,000/- Rs. 3,500/- Rs. 4,000/-
POS & MOS Members Rs. 500/- Rs. 3,000/- Rs. 3,500/-
PG Students Rs. 500/- Rs. 2,000/- Rs. 2,500/-
(PG Students Should inclose Certificate or Letter from the HOD)

Payment Details

  • DD/ Cheque should be in favour of "M/S National Institute of Ophthalmology, A/C CME Conference" payable at Pune.
  • Please add Rs 100 for outstation cheques – P.G. Students to attach a letter from HOD.


Rupee (In word)

D. D. /Cheque

Date

Bank

  • For Online registration :– Click Here

  • Cancellation Policy :- For all requests for cancellation of registration received on or before 15th March 2019, 75% of the registration amount will be refunded one month after the conference. No cancellation requests will be accept there after.